Lucia Mazur-Nicorici

Introduction

Patients with heart failure frequently present with varying degrees of skeletal muscle dysfunction, from early fatigue to sarcopenia and cachexia. Sarcopenia, defined as the loss of muscle mass and/or function, contributes to the physical dimension of frailty. Both conditions are associated with adverse outcomes in heart failure. Although sarcopenia and frailty often coexist, they are distinct syndromes with a bidirectional relationship with heart failure. According to European data, the prevalence of sarcopenia ranges from 20-50% in heart failure with reduced ejection fraction and approximately 18% in heart failure with preserved ejection fraction. This study aimed to evaluate sarcopenia among frail patients with chronic heart failure and to identify associated risk and protective factors.

Material and methods

A cross-sectional observational study was conducted on 44 frail patients with chronic heart failure. Data collection included clinical, functional, and anthropometric parameters, using the SARC-Calf questionnaire, gait speed and the Timed Up and Go test. Patients were stratified into three study groups according to frailty severity assessed by the Edmonton Frail Scale: Study Group 1 – mild frailty, Study Group 2 – moderate frailty, and Study Group 3 – severe frailty. Statistical analysis included Chi-square and Fisher’s exact tests. Odds Ratios with 95% Confidence Intervals were calculated. A p < 0.05 was considered statistically significant.

Results

Of the 44 patients included, 32 (72.7%) were women and 12 (27.3%) men, with a mean age of 67.3 ± 8.9 years. Sarcopenia risk (SARC-Calf ≥4) was identified in 56.8%, and severe sarcopenia in 15.9%, exclusively among women. Functional impairment was present in 88.9% of Study Group 1, 91.7% of Group 2, and 100% of Group 3. Arterial hypertension (71.4%), diabetes mellitus (57.1%), and obesity (42.8%) were more prevalent among sarcopenic patients. C-reactive protein levels >6 mg/L and elevated NT-proBNP were associated with sarcopenia risk (p = 0.039). Metformin use was linked to absence of sarcopenia (p = 0.008), while low physical activity, statin use, and inflammation were more frequent in sarcopenic patients.

Conclusions

Sarcopenia was highly prevalent in frail heart failure patients, particularly among women. Cardiac dysfunction, inflammation, and metabolic comorbidities are key contributors, highlighting the need for early screening and tailored interventions.

Abstract

Introduction

Even if boron is not yet recognized as an essential element for the human body, its insufficient intake is considered harmful, especially for the osteoarticular system. A daily intake of at least 3 mg of boron can fortify bone mass and prevent the onset of osteoarthritis, rheumatoid arthritis, and osteoporosis. This research aims to assess the morbidity caused by rheumatoid arthritis and inflammatory polyarthropathies in the population from regions with different boron concentrations in deep drinking water of the Republic of Moldova.

Material and methods

Two full-length descriptive observational studies were conducted: one on osteoarticular morbidity caused by rheumatoid arthritis and inflammatory polyarthropathies (incidence and prevalence), and one on boron concentrations in deep drinking water (public wells and artesian wells). Following national regulations, the Republic of Moldova was divided into three distinct boron-related areas, and in each of them, the boron trend overlapped with the morbidity trend.

Results

In the below-the-limit boron area, the research hypothesis was confirmed in two out of three districts, by overlapping osteoarticular morbidity with boron concentrations in deep drinking water and their trendlines. In the limit-level boron area, boron concentrations in drinking water do not appear to influence the studied osteoarticular morbidity in either district. In the above-the-limit boron area, unlike in previous research, trends for boron concentrations in public wells and artesian wells were opposite to those of the incidence and prevalence of rheumatoid arthritis and inflammatory polyarthropathies, confirming the research hypothesis.

Conclusions

Out of the three studied areas, the expected phenomenon of low morbidity and high boron concentrations, and vice versa, was observed in two below-the-limit boron districts and two above-the-limit boron districts. The results can be expanded upon in further research in the field.

Introduction

Osteoporosis remains a major public health issue, particularly affecting the elderly, and is characterized by decreased bone mass and deterioration of bone structure, increasing the risk of severe fractures. The development of specific and precise tools that allow for the identification and estimation of the influence of modifiable factors on the development of osteoporosis is an important step in early intervention for at-risk individuals.

Material and methods

The initial version of the questionnaire was created to identify modifiable factors contributing to the development of osteoporosis, including the type and frequency of drinking water consumption, water quality, knowledge about its mineral composition, dietary preferences, alcohol and tobacco use, physical activities, and stressful situations. The questionnaire initially contained 65 questions, organized into three sections. Five experts reviewed the content validity, evaluating the clarity, cultural and linguistic relevance, structure, and coherence of the questions. The feedback led to adjustments, reducing the questionnaire to 52 questions. A pre-test was conducted with 30 adults from the Republic of Moldova, confirming the validity and internal consistency of the questionnaire, with a Cronbach’s Alpha coefficient of 0.768.

Results

To ensure content validity, experts evaluated the questionnaire, and based on their comments and suggestions, semantic and syntactic reformulations and modifications were made. As a result, 13 questions were eliminated, reducing the second version of the questionnaire to 52 questions. During the pre-testing stage, the order and content of the questions were deemed appropriate by the respondents. The average time required to complete the questionnaire was 14.19 minutes (SD ± 1.567), with a minimum of 11.90 minutes and a maximum of 17.33 minutes. The sample used in the pre-testing stage included 30 respondents, the majority of whom (93.3%) were women. The respondents’ ages ranged from 25 to 72 years, with a mean age of 50.37 ± 2.6 years. The distribution of respondents was balanced between urban (53.3%) and rural (46.7%) areas. Regarding education level, 56.6% had higher education, 26.7% had secondary vocational education, and 16.7% had no higher education.

Conclusions

The study demonstrated that the new questionnaire is a valid and reliable instrument for assessing the impact of modifiable risk factors on morbidity due to osteoporosis. Ongoing research is necessary to refine and further validate the questionnaire within the broader population.